Individual
MARY JANN DEWITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1104 E ASHTON AVE STE 108, SALT LAKE CITY, UT 84106-2348
(801) 510-4547
Mailing address
22 W 1800 S, BOUNTIFUL, UT 84010-5243
(801) 296-8408
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
308921-2501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D1487
—
UT
Enumeration date
03/27/2006
Last updated
07/07/2018
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